First Communion & Reconciliation Registration

Child's Information

Child’s Name:

First Middle Last

Birth Date:

Baptismal Date:

Was child baptized at Sacred Heart Church:

Yes

(If not, we will need a copy of the child’s baptismal certificate.)

If not baptized at Sacred Heart, give the church and location of the child’s baptism:

Church City

Father's Information

Father’s Full Name:

First Middle Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Monther's Information

Monther's Full Name:

First Middle Last

Address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Please sign: I, the undersigned, hereby consent to the use of any videotapes, photographs, slides, audiotapes, or any other visual or audio reproduction in which my child may appear by Sacred Heart Church. I understand that these materials are being used for promotion of the religious education ministry of Sacred Heart Church. I understand that the promotional materials may or may not be used for internet, diocesan, community and/or national publications that promote the mission of the local Church. I release Sacred Heart Church from any liability connected with the use of my child’s picture or voice recording as part of any promotional, recruitment, or fundraising program.

Consented to by parent/legal guardian

First Last

Date

First Communion & Reconciliation Registration

Child's Information

Father's Information

Monther's Information

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